A scoping study on the social determinants of health and sugar consumption in the context of policy approaches for improving population health.

OBJECTIVES: To conduct a scoping review of existing research on the social determinants of health, sugar consumption and public health policy responses to address or improve health outcomes. METHODS: A total of 13 categories were developed to reflect the authors' interest in the overall focus on the social determinants of health, sugar as an independent risk factor, upstream policy action ('whole populations'), downstream policy action ('targeted') and two contemporary policy strategies (namely 'Vulnerable populations' and 'Proportionate Universalism'). The search strategy was then performed on MEDLINE (via Ovid) and Web of Science, and was limited to the English language. No time limits prior to when the database search was conducted in 2022 were set to explore the full extent of the literature in this field. RESULTS: Five hundred and sixty articles were retrieved, of which 181 met the criteria for review. When all categories were applied, the findings showed that 76% of papers focusing on sugar consumption as a risk factor for non-communicable diseases (NCDs) mentioned the social determinants of health. The majority of studies (60%) recommended downstream interventions, with 40% recommending 'upstream' interventions. A limited proportion (12%) of research work was published in dental journals. Research had been done using predominantly quantitative methods (66% of articles), with 24% of studies adopting a mixed methods approach, and 8% being exclusively qualitative. Research on contemporary strategies for sugar reduction were focused on the 'Global North' and 98% of papers used individual level data focused on targeted approaches, highlighting that there is little direct evidence for contemporary strategies aimed at reducing sugar consumption. CONCLUSIONS: Whilst the majority of public and dental health research argues that there is a need to address the social determinants of health, the findings from this study highlight that very few empirical studies have been designed to directly inform contemporary strategies for sugar reduction. More research is therefore needed that can directly assess the evidence for contemporary strategies in public health policy.

Correction: Implementation of Genomic Surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

[This corrects the article DOI: 10.1371/journal.pgph.0001455.].

Implementation of genomic surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

The COVID-19 pandemic highlighted the importance of global genomic surveillance to monitor the emergence and spread of SARS-CoV-2 variants and inform public health decision-making. Until December 2020 there was minimal capacity for viral genomic surveillance in most Caribbean countries. To overcome this constraint, the COVID-19: Infectious disease Molecular epidemiology for PAthogen Control & Tracking (COVID-19 IMPACT) project was implemented to establish rapid SARS-CoV-2 whole genome nanopore sequencing at The University of the West Indies (UWI) in Trinidad and Tobago (T&T) and provide needed SARS-CoV-2 sequencing services for T&T and other Caribbean Public Health Agency Member States (CMS). Using the Oxford Nanopore Technologies MinION sequencing platform and ARTIC network sequencing protocols and bioinformatics pipeline, a total of 3610 SARS-CoV-2 positive RNA samples, received from 17 CMS, were sequenced in-situ during the period December 5th 2020 to December 31st 2021. Ninety-one Pango lineages, including those of five variants of concern (VOC), were identified. Genetic analysis revealed at least 260 introductions to the CMS from other global regions. For each of the 17 CMS, the percentage of reported COVID-19 cases sequenced by the COVID-19 IMPACT laboratory ranged from 0·02% to 3·80% (median = 1·12%). Sequences submitted to GISAID by our study represented 73·3% of all SARS-CoV-2 sequences from the 17 CMS available on the database up to December 31st 2021. Increased staffing, process and infrastructural improvement over the course of the project helped reduce turnaround times for reporting to originating institutions and sequence uploads to GISAID. Insights from our genomic surveillance network in the Caribbean region directly influenced non-pharmaceutical countermeasures in the CMS countries. However, limited availability of associated surveillance and clinical data made it challenging to contextualise the observed SARS-CoV-2 diversity and evolution, highlighting the need for development of infrastructure for collecting and integrating genomic sequencing data and sample-associated metadata.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus.

Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Cariology consensus for undergraduates at dental schools in the Caribbean region.

AIM: To obtain a consensus on the domains of cariology for undergraduates in dental schools in the Caribbean. MATERIALS AND METHODS: Dental school deans from the Dominican Republic (DR) and Puerto Rico (PR) were invited to participate. Afterwards, 24 cariology faculty members from the dental schools in the DR received a 40-h workshop on the current understanding of dental caries. Then, representatives from participating dental schools in the DR and PR were divided into six groups and tasked with exploring the cariology domains described in the European and Colombian consensus. For each domain, the competencies in what the dental student, upon graduation, would have to (1) be proficient in, (2) have knowledge of, (3) and be familiar with were described. Two cariology consensus meetings to work on the domains and suggest changes for the Caribbean region were done, and representatives from the DR and PR agreed on a cariology consensus. For the second stage, Caribbean English-speaking countries were invited to participate in the consensus. Meetings were held with representatives from dental schools in Trinidad and Tobago (TT) and Jamaica (J) to include their suggestions on each consensus domain. RESULTS: A total of 15 dental schools (DR = 12; PR = 1; TT = 1; and J = 1) participated; they agreed on a new consensus considering the realities of the Caribbean participating countries. CONCLUSION: A cariology consensus for undergraduates was achieved for 15 dental schools in the Caribbean region. This accomplishment will promote a shift for the Caribbean dental schools' graduates towards a current understanding of dental caries.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus

Abstract Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Oral Health Knowledge, Attitudes and Behaviour of Parents and Caregivers of Preschool Children: Implications for Oral Health Promotion.

PURPOSE: The aim of this study was to describe oral health knowledge, attitudes and behaviours of parents and caregivers of preschool children in order to inform an oral health promotion strategy. MATERIALS AND METHODS: A sample of parents and caregivers of children attending nine randomly selected preschools in central Trinidad were invited to complete a self-administered questionnaire on early childhood oral health. RESULTS: A total of 309 parents and caregivers participated: 88% were female, 74.4% were of Indian ethnicity, with 50.4% in manual employment, and 50.2% educated to secondary level. 59.1% felt a child's first dental visit should be when all primary teeth are present. 64% had not taken their child for a dental visit. 81.6% rated their child's oral health as good or better and 28% would want an asymptomatic, decayed primary tooth extracted rather than filled. Over 80% used fluoride toothpaste. 52.8% always supervised their child's toothbrushing, and 44% claimed to be using the recommended pea-size amount. 26.2% reported having used a sweetened feeding bottle or infant feeder at night. CONCLUSION: Parents and caregivers of preschool children in this sample had reasonable oral health knowledge. However, despite generally positive attitudes towards preventive oral healthcare, confusion regarding dental attendance, supervised toothbrushing, fluoride use and sugar intake suggests that these items require particular emphasis in oral health promotion programmes aimed at improving early childhood oral health.

The Use of the Slipping Slipper Sign to Explore the Connection between the Feet and the Mouth in Patients with Diabetes Mellitus.

OBJECTIVE: Both periodontal disease and peripheral neuropathy are complications associated with poorly controlled diabetes. This study aimed to determine whether periodontal disease was more prevalent and more severe among patients with severe diabetic peripheral neuropathy. METHODS: A case-control study was performed; 46 patients with and 48 without the slipping slipper sign (SSS)-a surrogate clinical marker for severe peripheral neuropathy-were recruited from a diabetic outpatient clinic. Demography and data from the Basic Periodontal Examination (BPE) were assessed, in addition to the patients' periodontal health by 2 examiners blinded to patients' SSS status. Multivariate logistic regression was used to evaluate the associations between the risk factors for and the presence of the SSS, adjusting for age, gender, and ethnicity. RESULTS: The mean age of the sample was 55.8 years (±10.69 years). Most of the participants (77.7%) had either never been to a dentist or had last attended a dental clinic more than a year before this examination, and 83% did not have a dentist. Periodontal disease was advanced in 61.7%, and there was no association between the SSS and periodontal disease. Dental-service utilization variables were significantly associated with the SSS. Patients who did not have a regular dentist were more than 7 times more likely to have the SSS than were those who did (OR = 7.70; 95% CI: 1.12 53.21). CONCLUSION: In diabetic patients, oral health-related risk factors, such as not having a dentist, wearing a denture or dentures, and visiting a dentist once a year or more, may be associated with systemic complications, including peripheral neuropathy. Early collaboration between dentists and doctors on the care of patients with diabetes is recommended.

Prevalence and Factors Associated with Dentin Hypersensitivity among Adult Patients Attending a University Dental Clinic in Trinidad, West Indies. A Cross-Sectional Study.

Purpose: To assess the prevalence of dentin hypersensitivity (DH) in an adult population and explore its association with sociodemographic variables, dietary habits and oral health behaviours as there is very little data on this from the Caribbean.
Materials and Methods: A cross-sectional survey was conducted of consecutive dental patients (18 years and over) attending the UWI School of Dentistry polyclinic. Following informed consent, dental examinations were performed and the presence of DH was assessed clinically by sensitivity to an air blast on individual teeth. Patients were also given a questionnaire. Their answers were processed using statistical software (SPSS version 24). Associations between variables were analysed using the chi-squared test.
Results: 300 patients participated, with an age range of 18-81 years and a mean age of 44.7 years (SD 15.7). 68.8% were female and the main ethnic groups were African (45.8%), Indian (29.8%) and mixed (24.4%). Over half of the participants (54.9%) reported a history of sensitive teeth and 52% reported sensitivity to the air syringe on one or more teeth. Based on multivariate logistic regression, a history of sensitive teeth was significantly associated with Indo-Trinidadian ethnicity (OR 2.24, 95% CI: 1.23, 4.45), a history of tooth grinding or jaw clenching (OR 0.38, 95% CI: 0.19, 0.76) and consumption of citrus fruits one to two times daily (OR 0.22, 95% CI: 0.06, 0.85). Those who experienced vomiting irregularly were more likely (OR 2.31, 95% CI: 0.96, 5.54) to have DH.
Conclusion: Prevalence of dentin hypersensitivity was high among this sample of dental patients and was associated with ethnicity, tooth grinding and dietary practices.

Oral health among children attending an oncology clinic in Trinidad.

Objectives: Little is known about the oral health of paediatric oncology patients in the Caribbean. Poor oral health can complicate oncology treatment, negatively affecting a child's health. In children undergoing chemotherapy or bone marrow transplant, odontogenic infections can progress to life-threatening sepsis. The aim of this study is to investigate the oral health among children attending an oncology clinic in Trinidad. Material and Methods: Sample population included paediatric oncology patients attending a children's hospital in Trinidad. Subsequent to obtaining informed consent, a 14-item questionnaire was administered to parents/caregivers. An intra-oral examination was undertaken by two dentists to assess soft tissues, gingival health, and dentition status, using visual examination only. Results: Seventy-one children and their caregivers participated in the study. The children consisted of both patients warded or attending as outpatients; 53.5% of patients were male and the mean age 6.64 (SD 3.33) years with a range of 1 to 15 years. Gingivitis and mucositis were present among 41.3% and 3% of patients, respectively. The prevalence of visible dental caries was 54.3%. Caries experience (dmft) was 2.28 (SD 3.63), and for those children with some caries experience (dmft > 0), this was 5.59 (SD 3.72). The majority (62.5%) had never visited a dentist. The most common dental treatment needs were dental prophylaxis (98.4%) and restorative treatment (50.8%). Acute lymphocytic leukaemia (39.1%) was the most common malignancy among this sample, and patients were at varying stages of cancer treatment. Conclusions: Oral health among this sample of paediatric oncology patients was generally poor, with untreated caries being common, and the majority of children not having had any previous dental care. Preventive dental care for these patients should include oral hygiene instruction, dietary advice, topical fluoride application along with management of carious lesions, and odontogenic infections. This preliminary study highlights the need for closer collaboration between general dental practitioners, paediatric dentists, and paediatric oncology physicians, in caring for these patients.

Knowledge, attitudes and behaviour towards preventive oral care in early childhood among paediatricians in Trinidad and Tobago: findings of a national survey.

OBJECTIVE: To determine paediatrician's knowledge and attitudes about oral health in Trinidad and Tobago. DESIGN AND METHOD: A pre-tested questionnaire was sent out via survey monkey to 70 out of 75 paediatricians registered with the Medical Board of Trinidad and for whom email addresses were available. Hard copies of the questionnaires were delivered to the paediatric departments of the Eric Williams Medical Sciences complex. Paediatricians that were unable to complete the questionnaire online were asked to complete hard copies. RESULTS: Forty-nine paediatricians responded, yielding a response rate of 70%. Most (95.9%) of the participants had positive views about routine dental visits, but yet only 28.6% advised a first dental visit between the ages 6 months and 1 year. Although the majority (91.8%) had positive views on fluoride supplementation, knowledge of appropriate fluoride dosages was not in keeping with current guidelines. Mixed views on the role of breastfeeding as a risk factor for developing decay were seen among respondents; 63.3% of the paediatricians indicated that they did not receive any education on the oral health of young children during their specialty training, and most felt they required additional training in this area. CONCLUSIONS: Paediatricians in Trinidad and Tobago demonstrated positive attitudes toward oral health. However, their knowledge with respect to oral disease prevention including the use of fluoride, and timing of the first dental visit appear to be lacking. Paediatricians may benefit from continuing education with regards to the oral health of children.

Oral health-related quality of life and early childhood caries among preschool children in Trinidad.

BACKGROUND: Early childhood caries (ECC) is a public health problem in developed and developing countries. The purpose of this study was to describe the relationship between oral health-related quality of life (OHRQoL) and ECC among preschool children in a Caribbean population. METHOD: Parents/primary caregivers of children attending nine, randomly selected preschools in central Trinidad were invited to complete an oral health questionnaire and have their child undertake an oral examination. The questionnaire included the Early Childhood Oral Health Impact Scale (ECOHIS). Visible caries experience was assessed using WHO criteria. Logistic regression models were used to determine the factors associated with OHRQoL and ECC. RESULTS: Three hundred nine parents/caregivers participated in the study (age-range 25-44 years) and 251 children (mean age 3.7 years) completed oral examinations. Adjusting for other factors, the odds for a child aged 4 years of having dental caries were greater than the odds for a child aged 3 years (OR 3.61; 95% CI (1.76, 6.83). The odds for children having difficulty drinking hot or cold drinks were greater for those with dental caries than the odds for children who have no such difficulty. Similarly, the odds for children who had difficulty eating were greater for those with dental caries than the odds ratios for children who had no difficulty eating (OR 8.29; 95% CI (2.00, 43.49). Adjusting for the effects of other factors, the odds of parents/caregivers feeling guilty were greater if their child had experienced dental caries in comparison to parents/caregivers whose child did not have dental caries (OR 3.50; 95% CI (1.32, 9.60). Adjusting for other factors, the odds of parents/primary caregivers having poor quality of life was increased when they had a child with a dmft in the range 1-3 (OR 2.68; 95% CI (1.30, 5.64) dmft > 4 (OR 8.58; 95%CI (3.71, 22.45), in comparison to those whose child had a dmft = 0. CONCLUSION: In this sample of preschool children OHRQoL was associated with ECC. More negative impacts were found in children with a greater severity of visible caries experience. This suggests the need for strategies to prevent and manage ECC in this Caribbean population.

Prevalence of Enamel Developmental Defects and Relationship with Early Childhood Caries in Trinidad.

PURPOSE: The purpose of this study was to describe the prevalence of developmental defects of enamel (DDE) and their relationship with early childhood caries (ECC) among preschool children in Trinidad. METHODS: A cross-sectional oral health survey of 251 three- to five-year-old preschool children was undertaken in central Trinidad. The decayed, missing, and filled primary teeth (dmft) index and the DDE index were used to measure visible caries experience and enamel developmental defects, respectively. RESULTS: Sixty-three children (25.1 percent) had some type of DDE. The most common defects were diffuse opacities and demarcated opacities. A greater severity of visible caries experience was associated with enamel opacities and hypoplasia (P<0.05). CONCLUSIONS: DDEs are prevalent among this group of preschool children in Trinidad and are risk factors for ECC, which emphasizes the importance of preventive oral health care in early childhood for these high-risk children.

The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study.

BACKGROUND: Motivational Interviewing (MI) has been used across primary healthcare and been shown to be effective in reducing the prevalence of early childhood caries (ECC) in preschool children. This study aimed to compare the effect of MI, in contrast to traditional dental health education (DHE), on oral health knowledge, attitudes, beliefs and behaviours among parents and caregivers of preschool children in Trinidad. METHOD: The design of this exploratory study included a cluster randomised controlled trial and semi-structured focus groups. Six preschools (79 parents and caregivers) in Eastern Trinidad were randomly assigned to a test or control group (3 preschools in each group). Parents and caregivers in the test-group (n = 25) received a talk on dental health using an MI approach and the control-group (n = 54) received a talk using traditional DHE. Both groups received additional, written dental health information. The MI group also received two telephone call follow-ups as part of the MI protocol. Both groups were given questionnaires before the talks and four months later. Question items included oral health knowledge, beliefs, attitudes, brushing behaviour, oral health self-efficacy, oral health fatalism and a specific instrument to asses 'readiness for change', the Readiness Assessment of Parents Concerning Infant Dental Decay (RAPIDD). Participants in the test-group were also invited to take part in a focus group to share their views on the dental health talk. RESULTS: At four month follow-up, knowledge items on fluoride use, tooth brushing, dietary practice and dental attendance increased in both the test (DHE + MI) and control (DHE) groups ((p < 0.05, Chi Square test). In the test-group there were increases in mean child tooth brushing frequency and reduction in oral health fatalism (p < 0.05 t-test). Findings from a thematic analysis of the focus group suggested that the MI talk and telephone follow-up were well accepted and helpful in supporting parent and caregiver efforts to improve oral health practices for their preschool children. CONCLUSION: In this exploratory controlled study there was some evidence that using an MI approach when delivering oral health information had a positive effect on parent/ caregiver oral health knowledge, attitudes and behaviours compared to traditional DHE. There is need for further research involving the use of brief-counselling techniques in this Caribbean population.

Oral health among the elderly in 7 Latin American and Caribbean cities, 1999-2000: a cross-sectional study.

BACKGROUND: To describe the prevalence of missing teeth, use of bridges and dentures and unmet dental needs among those aged 60 years and above. The associations of these conditions with socio-demographics, type 2 diabetes mellitus and depression were also studied. The work was carried out in 7 Latin American and Caribbean (LAC) cities in 1999-2000. METHODS: A secondary analysis was conducted on the Survey of Health and Well-Being of Elders (SABE) dataset. The 7 cities were Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. This survey did not employ any oral examinations. Descriptive statistics, chi-square and regression analysis were used to test for associations. RESULTS: Data for 10 902 persons were analyzed. Females made up 62% of the population. Across the SABE population, between 93.7% (Mexico City) to 99.9% (Santiago) reported missing teeth, with an average of 97.5%. Of those with missing teeth, between 55.1% (Mexico City) and 82.4% (São Paulo) reported having bridges or dentures, with an average of 70.1% across all SABE cities. The proportion of the SABE population with 'unmet dental needs' ranged from 85.8% (Santiago) to 98.4% (Havana), with an average of 94.5%. Bridgetown, São Paulo and Mexico City demonstrated a statistically significant association between aging and tooth loss. Generally a greater proportion of females (97.6%) reported tooth loss compared with males (96.8%), but in only São Paulo and Montevideo was there a statistically significant association between sex and tooth loss. Generally those with higher education reported less tooth loss, primary education (97.6% had tooth loss), secondary (96.8%) and tertiary (94.7%). All the SABE cities except Buenos Aires demonstrated a statistically significant association between tooth loss and education. CONCLUSIONS: The prevalence of missing teeth, use of bridges and dentures and unmet dental needs were high in the SABE cities in 1999-2000. In general across the SABE cities, the elderly with the most missing teeth were less educated or less likely to be a professional. They tended to be not working and were receiving a pension. Additionally they were less likely to report their health as 'excellent', were diabetic and were more likely to give responses suggestive of depression.

A review of the global literature on dental therapists.

OBJECTIVE: Access to adequate oral health care is deficient in many parts of the world. Many countries are now using dental therapists to increase access, particularly for children. To inform the discussion on dental therapists in the workforce, particularly in the United States, the W.K. Kellogg Foundation funded a review of the global literature to identify as many documents as possible related to the practice of dental therapists since the establishment of the School Dental Service in New Zealand in 1921. METHODS: Consultants in each of the countries considered to have a substantive literature on dental therapists were asked to participate in the research; seventeen in total. In addition to identifying and reviewing published articles, a focus of the research was on identifying 'gray' documents. Standard databases were searched for key words associated with dental therapists. In addition, searches were conducted of the governmental and dental association websites of all countries known to have dental therapists in their oral health workforce. RESULTS: Fifty-four countries, both developing and developed, were identified where dental therapists are members of the workforce. Eleven hundred documents were identified from 26 of these countries, with over 2/3 of them cited in the published monograph. Reliable evidence from the related literature and verbal communication confirmed the utilization of dental therapists in an additional 28 countries. Thirty-three of the countries were members of the Commonwealth of Nations, suggesting a mechanism of spread from New Zealand. Variable lengths of training/education existed for dental therapists with the tradition being 2 years postsecondary. In a few countries, the training of therapists and hygienists is now being combined in a three academic year program. Historically, dental therapists have been employed by government agencies caring for children, typically in school-based programs. Initiatives in some countries allow limited care for adults by dental therapists with additional training. CONCLUSIONS: The evidence indicates that dental therapists provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and where their use is established, by the dental profession.

Socio-behavioural factors and early childhood caries: a cross-sectional study of preschool children in central Trinidad.

BACKGROUND: Early childhood caries (ECC) is a public health problem due to its impact on children's health, development and well being. Little is known about early childhood oral health in the West Indies or the influence of social and behavioural factors on the prevalence and severity of early childhood caries in this preschool population. The aims of this study were to describe the prevalence and severity of ECC in preschool children in a region of central Trinidad and to explore its relationship with social and behavioural factors. METHOD: A cross-sectional survey was undertaken on children aged 3-5 years-old from a random sample of preschools in central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis / cavitation at d3). A self-reported questionnaire was distributed to all parents and caregivers. Variables included socio-demographics, oral health knowledge, attitudes and behaviours, visible caries experience and treatment need. RESULTS: 251 children were examined, 50.2% were male with a mean age of 3.7 years (SD 0.67) and 71% were of Indian ethnicity. The prevalence of ECC was 29.1% and the prevalence of severe early childhood caries (S-ECC) was 17.5%. 29.9% of children had some treatment need, with 12% in need of urgent care or referral. Poisson generalized linear mixed model analysis found a higher rate of visible caries experience for children who ate sweet snacks more than twice a day (p < 0.001), had poorer parental dental health ratings (p < 0.0001), a previous dental visit (p < 0.0001) and difficulty finding dental care (p < 0.001). CONCLUSION: The prevalence and severity of ECC in central Trinidad was related to oral health behaviours and access to dental care. Oral health promotion should include more supportive and practical advice for parents and caregivers of preschool children along with improved access to dental care to enable primary prevention and management of ECC.

Oral healthcare of preschool children in Trinidad: a qualitative study of parents and caregivers.

BACKGROUND: Little is known about oral health in early childhood in the West Indies or the views and experiences of caregivers about preventive oral care and dental attendance The aims of this study were to explore and understand parents and caregivers' experience of oral healthcare for their preschool aged children and how, within their own social context, this may have shaped their oral health attitudes and behaviours. These data can be used to inform oral health promotion strategies for this age group. METHOD: After ethical approval, a qualitative study was undertaken using a focus group approach with a purposive sample of parents and caregivers of preschool children in central Trinidad.Group discussions were initiated by use of a topic guide. Audio recording and field notes from the three focus groups, with a total of 18 participants, were transcribed and analysed using a thematic approach. RESULTS: Despite some ambivalence toward the importance of the primary teeth, the role of fluoride and confusion about when to take a child for their first dental visit, most participants understood the need to ensure good oral hygiene and dietary habits for their child. Problems expressed included, overcoming their own negative experiences of dentistry, which along with finding affordable and suitable dental clinics, affected their attitude to taking their child for a dental visit. There was difficulty in establishing good brushing routines and controlling sweet snacking in the face of many other responsibilities at home. Lack of availability of paediatric dental services locally and information on oral health care were also highlighted. Many expressed a need for more contact with dental professionals in non-clinic settings, for oral health care advice and guidance. CONCLUSION: Parents and caregivers in this qualitative study showed generally positive attitudes towards oral health but appear to have encountered several barriers and challenges to achieving ideal preventive care for their child, with respect to healthy diet, good oral hygiene and dental attendance. Oral health promotion should include effective dissemination of oral health information, more practical health advice and greater access to dental care for families with preschool children.